Regina Roundtable Report

In Regina, the Minister of State met approximately 16 Saskatchewan public health stakeholders.

They advised the Minister to consider the following factors in building a Public Health Agency of Canada.

1. Regarding a Mandate for a Public Health Agency

• Mandate for an Agency is not just about infectious disease:
  • Must also be about chronic disease; and,
  • Suicide and motor vehicle accidents are also big killers. The Agency will have to work on those kinds of issues, even if the political opportunity to create the Agency arises because of infectious disease crises.
• Agency has to create opportunities for Canadians to have healthy choices at their disposal. For example, alcohol is same price across Saskatchewan, but milk is 5 times as expensive in northern parts of the province as in the south;
• Agency must be closely and quickly linked to the research community:
  • This includes links to US research; and,
  • Agency needs an ability to contract applied research quickly to respond to emerging threats.
• Mandate should be promotion and protection; and,
• Agency has a key role to transfer knowledge between public health regions across the country:
  • Local authorities do not have the resources to share information and coordinate approaches nationally; and,
  • Real measure of the Agency's success will be the ability to engage communities.

2. Regarding Operational Strategies for a Public Health Agency

An Agency should consider the following:

• Undertaking ongoing citizen engagement:
  • The Romanow Commission on the Future of Health Care taught Canada that citizen engagement works;
  • Current expert consultation is not citizen engagement; and,
  • Citizens understand the determinants of health and they want to have that consultation.
• The unique priorities of First Nations communities:
  • How will the Agency combine evidence-based public health practice with traditional health practice when dealing with such matters as diabetes, smoking, addiction, etc?
  • Offering "guidelines" rather than "standards" would allow a new Agency to engage the unique needs and abilities of First Nations communities;
  • On-line public health education is a "huge problem" in many First Nations communities because of access to technology; and,
  • First Nations need true collaboration with Health.
• Agency needs to look at the social determinants of health - like housing - especially with regard to helping the following groups be able to pursue healthier lifestyles:
  • Aboriginal communities;
  • Women living in poverty; and,
  • Women living in rural and remote areas.
• Agency can only keep its focus if it has set, and is working towards, a national public health strategy:
  • This should be an early product - to be delivered through the federal-provincial-territorial network; and,
  • The network should start with setting health priorities.
• Linking closely with community-based organizations:
  • They deliver programs most effectively; and,
  • The Agency should link these community-based organizations with the research community to evaluate what community practices work and what don't.
• Looking at health delivery in Fransaskois communities as a model for delivering information to front-line workers:
  • We are building a network of services for our community - it could be a model for the Agency; and,
  • Distance learning - we have a system in Saskatchewan that connects all our community centres - and we are open to partnering.
• Advancing on mandatory food labeling and increasing the number of mandatory food inspections;
• An Agency would have to plan "inter-jurisdictional" with provincial, territorial and local governments:
  • No room for federal unilateral action that creates tension in the federation; and,
  • Can't be simply a debate about money. It must also be about the fundamental principles of good health care for all Canadians.
• Setting and applying public-health standards across the country:
  • Currently, different governments decide on which standards to apply; and,
  • Public Health Agency of Canada should focus on quality assurance of public health standards throughout the country.
• Working closely with veterinarians and animal-health research:
  • Large number of new and emerging diseases in people have their origins in animals.

3. Investments

Participants urged an Agency to focus on the following priority investments:

• Developing a network for public health training:
  • The federal Agency can't rob the best public health talent from across the country. It has to build capacity, develop ways to train people and make access to training easier;
  • This should include public health units training public health professionals in the same way that teaching hospitals train doctors and nurses;
  • Training should be both applied and academic - so that academics can experience real work public health issues, and public health practitioners develop useful research questions; and,
  • Front line staff have problems with computer-based distance learning in public health:
• Few in remote areas have access to a computer; and,
• Even if they do, there is no one to cover their work while they are studying.
• Local H.R. capacity in public health is more important than a national vaccine stockpile:
  • Public health staff at the local level allows us to respond to daily issues, and not just crises.
• Develop a health status and infectious disease surveillance system:
  • There has been a problem getting investment because governments believe the need for surveillance isn't as great as the need for an advanced diagnostic machine (e.g. MRI).
• Governments cannot choose between addressing waiting lists and addressing public health. They have to manage both:
  • Need to better integrate public health into the rest of the health system; and,
  • Must protect funding so that funding for public health units doesn't get siphoned off by needs of the acute care system.

4. Public Health Issues

Participants also raised concerns about specific public health issues:

• Mental health services have never really been addressed in the discussion about the public health agency of Canada.

5. Chief Public Health Officer

• The Chief Public Health Officer has to be a key public health leader - not a manager, but a public leader;
• The Chief Public Health Officer should relate to the World Health Organization the way that Canada's chief veterinarian currently relates to the multilateral organization monitoring international animal epidemics in Paris; and,
• The Chief Public Health Officer's advisory board should not be a governance body. It should be strictly advisory:
  • It should not include MPs;
  • Should have no more than 20 people; and,
  • No more than four members should be provincial, and no more than four should be federal.

Other members should be from public health groups - including at least one veterinarian and a livestock expert.